{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T08:06:43Z","timestamp":1785571603881,"version":"3.56.0"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T00:00:00Z","timestamp":1752710400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Australian Government National Health and Medical Research Council"},{"DOI":"10.13039\/501100025520","name":"Medical Research Future Fund","doi-asserted-by":"crossref","award":["ID: App201617"],"award-info":[{"award-number":["ID: App201617"]}],"id":[{"id":"10.13039\/501100025520","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001030","name":"National Heart Foundation of Australia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Significant variability in cardiac rehabilitation (CR) programme content and delivery persists. Quality improvement interventions enhance adherence to standards and reduce variability, yet synthesized evidence of their characteristics and effectiveness in CR is lacking. This meta-analysis aimed to evaluate the effects of quality improvement interventions on CR processes and patient outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Scopus, CENTRAL, Medline, Embase, and CINAHL were searched for studies published from January 2000 to November 2024. Study selection in Covidence, data extraction, and risk of bias assessment were completed. Where possible, meta-analyses were conducted using RevMan v5.3, random-effects model. Outcomes not suitable for meta-analysis were reported narratively. Fifteen studies (76 856 participants) were eligible, including 1 randomized controlled trial, 1 retrospective observational study, and 13 pre\u2013post studies. Meta-analysis of 11 studies (17 010 participants) showed that quality improvement interventions significantly improved CR referral [odds ratio (OR) 5.25; 95% confidence interval (CI) 3.11, 8.87]. From subgroup analyses, patient education had the largest effect (OR 8.37; 95% CI 4.32, 16.21), followed by technology (OR 5.56; 95% CI 2.67, 11.58) and process changes (OR 5.31; 95% CI 2.53, 11.12). Narrative synthesis indicated that quality improvement interventions led to significant improvements in time from discharge to scheduled appointment (1\/1 studies), attendance (3\/4), prescription of guideline-directed medical therapy (1\/1), and completion (1\/1). Few studies reported patient outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Quality improvement interventions improve referral to CR by up to eight times. While caution is warranted, quality improvement interventions may also lower wait times and increase programme utilization. Future studies are needed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration PROSPERO<\/jats:title>\n                    <jats:p>CRD42024557586<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Lay summary<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcaf067","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T10:11:28Z","timestamp":1752747088000},"page":"1460-1473","source":"Crossref","is-referenced-by-count":7,"title":["Effectiveness of quality improvement interventions in cardiac rehabilitation on processes and patient outcomes: a systematic review and meta-analysis"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-5428-501X","authenticated-orcid":false,"given":"Sanuri","family":"Wijesekera Kankanamge","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney , Sydney, New South Wales 2006 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5588-9351","authenticated-orcid":false,"given":"Robyn","family":"Gallagher","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney , Sydney, New South Wales 2006 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7063-3610","authenticated-orcid":false,"given":"Sherry L","family":"Grace","sequence":"additional","affiliation":[{"name":"Faculty of Health, School of Kinesiology and Health Science, York University , North York, Ontario , M3J 1P3","place":["Canada"]},{"name":"KITE Research Institute, Toronto Rehabilitation & Peter Munk Cardiac Centre, University Health Network, University of Toronto , Toronto, Ontario , M5G 2A2","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9961-2079","authenticated-orcid":false,"given":"Ling","family":"Zhang","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney , Sydney, New South Wales 2006 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Cunich","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, Boden Initiative, Charles Perkins Centre, Central Clinical School, Sydney Medical School, The University of Sydney , Sydney, New South Wales 2006 ,","place":["Australia"]},{"name":"Cardiovascular Initiative, Implementation and Policy, The University of Sydney , Sydney, New South Wales 2006 ,","place":["Australia"]},{"name":"Sydney Institute for Women, Children and Their Families, Sydney Local Health 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